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Serum S100beta release after coronary artery bypass grafting: roller versus centrifugal pump
S Ashraf1, K Bhattacharya, S Zacharias
1Yorkshire Heart Centre, Leeds General Infirmary, United Kingdom.
Insights
Centrifugal pumps did not significantly reduce S100beta levels, a marker of brain injury, after coronary artery bypass grafting. However, elevated S100beta levels were linked to longer intubation times post-surgery.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Biomarkers
Background:
- Coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB) can cause cerebral injury.
- Microemboli from CPB are a suspected cause of this injury.
- S100beta protein levels increase post-CABG and correlate with poorer outcomes.
Purpose of the Study:
- To investigate the potential neuroprotective benefits of centrifugal pumps compared to roller pumps during CPB.
- To use S100beta as a biomarker for cerebral injury in patients undergoing CABG.
Main Methods:
- Thirty-two patients undergoing CABG were randomized into two groups.
- Serial serum samples were collected preoperatively and at multiple time points after CPB.
- S100beta levels were measured using a new immunoluminometric assay.
Main Results:
- Postoperative S100beta levels were significantly elevated compared to preoperative levels in both groups.
- No significant difference in S100beta levels was observed between centrifugal and roller pump groups.
- Higher 24-hour S100beta levels correlated with longer intubation times.
Conclusions:
- Centrifugal pumps did not significantly reduce S100beta release during CPB.
- S100beta levels increase after CABG, indicating cerebral injury.
- Sustained elevation of S100beta is associated with prolonged intubation.
Background:
Microemboli generated during cardiopulmonary bypass (CPB) are implicated in the cerebral injury seen after coronary artery bypass grafting. Centrifugal pumps generate fewer microemboli than roller pumps. Increased S100beta levels have been reported after coronary artery bypass grafting, with levels greater than 1 ng/mL resulting in poorer neuropsychologic outcome. This study investigated the potential neurologic benefits of centrifugal pumps, by using S100beta as a marker for cerebral injury.
Methods:
Thirty-two patients who had coronary artery bypass grafting were randomly assigned to two groups. Serial blood samples (preoperative, end of bypass, 30 minutes, and 2 and 24 hours after cardiopulmonary bypass) were taken and the serum analyzed for S100beta using a new immunoluminometric assay.
Results:
Both groups were matched for age, number of grafts, and cardiopulmonary bypass and cross-clamp times. Postoperative serum S100beta levels were significantly higher in both groups than preoperative levels. Peak S100beta levels did not correlate with cardiopulmonary bypass time; however, 24-hour S100beta levels correlated with intubation time r = 0.40, p = 0.04). Th ere was no significant difference in S100beta levels between the groups at any of the time points.
Conclusions:
S100beta levels increased after coronary artery bypass grafting. Centrifugal pumps do not significantly decrease S100beta release. Persistently increased S100beta levels are associated with longer intubation times.